The Causes,Course, and Consequences of Anger Problems in Veterans Returning to Civilian Life

While anger is a common problem for veterans returning from wars in Afghanistan and Iraq, veterans' understanding of the causes, course, and consequences of anger has not been explored. We conducted this qualitative study to learn veterans' perspectives about their anger problems. We identify and describe three distinct patterns of anger problems that emerged as a consequence of (a) loss of structure during reintegration to civilian life, (b) moral injury sustained through a wartime experience, and (c) posttraumatic stress disorder (PTSD). While anger problems tended to be short lived for those experiencing loss of structure, problems persisted for years for those with moral injury or PTSD. Anger following all three patterns negatively impacted veterans' experiences with reintegration. We discuss the implications of these findings.     

Stories that move? Peer athlete mentors' responses to mentee disability and sport narratives

BackgroundHow people respond to the stories people tell matters. Past research demonstrates that there are varied responses to the narratives individuals with spinal cord injury (SCI) use. Yet, no research has explored how peer athlete mentors with SCI respond to their mentees' stories about sport participation that are framed in different disability narratives.PurposeTo explore how peer athlete mentors respond to four mentees' vignettes representing various attitudes towards adapted sport.MethodsThirteen peer athlete mentors discussed these vignettes in hour-long interviews; their responses were analysed using a dual narrative analysis.ResultsPeer athlete mentors tailored their responses to each individual vignette. Specifically, responses to the most open vignettes were tailored to the mentees' disability narratives and provided a variety of resources and sport information. This type of response to mentees' stories can support and validate these mentees' experiences and increase the likelihood that mentees will try sport. In contrast, peer athlete mentors' responses to the heavily resistant vignettes contained limited information about sport. These responses also challenged the mentees' disability narratives. These types of responses may be counter-productive as they invalidate the mentees' experiences with sport and SCI and may further deter sport participation.ConclusionWhile peer athlete mentors tailored the information they would provide to mentees who use different disability narratives, they expressed difficulties responding to the heavily resistant narrative. Future peer athlete mentor training should address this difficulty by providing practice around how to communicate with individuals expressing resistant narratives.     

军事医学伦理学研究现状及进展

结合国内外相关文献,从军事医学伦理学的产生及其发展、军事医学伦理学的研究范畴及其发展、对军事医学伦理学的发展展望等方面进行总结分析。重点研究了军医职业带来的军事伦理学困境、军人战斗行为后的心理创伤和精神健康问题、对待战俘的军事医学伦理学问题、生物技术应用于军事的医学伦理问题、海外事务中军事医学伦理规范的建立、新军事革命对军事医学伦理学的需要等方面。未来,军事医学伦理学的发展必定是站在全球视野的合作与共赢,需要构建符合国际伦理需求的军事医学伦理规范,不断丰富和完善我国军事医学伦理学体系。

     

Enhanced retention of drop vertical jump landing technique: A randomized controlled trial

External focus instructions have been shown to result in superior motor performance compared to internal focus instructions. Using an EF may help to optimize current anterior cruciate ligament (ACL) injury prevention programs. The purpose of the current study was to investigate the effects of instructions on landing technique and performance by comparing an external focus (EF), internal focus (IF), video (VI) and control (CTRL) group. Subjects (age 22.50 ± 1.62 years, height 179.70 ± 10.43 cm, mass 73.98 ± 12.68 kg) were randomly assigned to IF (n = 10), EF (n = 10), VI (n = 10) or CTRL group (n = 10). Landing was assessed from a drop vertical jump (DVJ) in five sessions: pretest, two training blocks (TR1 and TR2) and directly after the training sessions (post test) and retention test 1 week later. Group specific instructions were offered in TR1 and TR2. Landing technique was assessed with the Landing Error Scoring System (LESS) and jump height was taken as performance measure. The results show that males in the VI group and females both in the VI and EF groups significantly improved jump-landing technique. Retention was achieved and jump height was maintained for males in the VI group and females both in the VI and EF groups. It is therefore concluded that EF and VI instructions have great potential in ACL injury prevention.     

A Comparison of Posttraumatic Growth After Acquired Brain Injury or Myocardial Infarction

Posttraumatic growth (PTG) is known to occur following acquired brain injury (ABI). It is not yet known to what extent PTG experiences following ABI are unique to the neurological nature of the injury. We investigated PTG in survivors of ABI or myocardial infarction (MI); MI is comparable to ABI but does not have a primary neurological element. Thirty-three ABI survivors (age M = 51.6, SD = 12.4; 52% male; years since injury M = 5.5, SD = 5.3) and 47 MI survivors (age M = 66.4, SD = 9.9; 79% male, years since injury M = 9.9, SD = 8.6) completed a survey including the Posttraumatic Growth Inventory (PTGI). Unadjusted analyses showed no significant group differences on PTGI total score (ABI M = 54.0, SD = 19.6; MI M = 54.6, SD = 23.6; d = .03, p = .902) or on any of the five subscales, but analyses adjusted for covariates showed that scores on “Relating to others” were higher in participants with ABI (unstandardized coefficient = 5.43; 95% CI .27, 10.60; p = .039). Open-ended comments revealed aspects of growth in both samples that were not directly captured by the five PTGI factors.     

Psychological Predictors of Neurobehavioral Symptoms in a Polytrauma Veteran Sample

Given the high prevalence of comorbid conditions found in polytrauma settings, effective screening measures are needed. Several screening tools are commonly used in polytrauma clinics within the Department of Veterans Affairs (VA). This study examined the use of three screening measures—the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and PTSD Checklist–Civilian Version (PCL-C)—to predict scores on the Neurobehavioral Symptom Inventory (NSI). Research suggests that the presence of mental health conditions, such as PTSD, shares a significant amount of variance with postconcussive symptoms. The investigators hypothesized that the PCL-C would be the best predictor of scores on the NSI. All subjects were administered the screening measures as part of an evaluation in an outpatient Level III polytrauma clinic. Regression analysis was used to determine which instrument might serve as the best predictor of NSI total scores. Regression analysis revealed that BAI, BDI-II, and PCL-C total scores were good predictors of NSI total scores, with the BAI accounting for the majority of the variance. Mental health conditions can account for higher scores on the NSI, and screening of other mental health conditions should be taken into account when reviewing the NSI for individuals in polytrauma settings.     

Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research

Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.     

Longitudinal study of quality of life in acquired brain injury: A self- and proxy-report evaluation

Background/ObjectiveAfter an acquired brain injury (ABI), the person remains with several impairments and disabilities that cause a decrease in his/her quality of life (QoL), which could change over time. The objective of the study was to analyse the evolution patterns of QoL in a sample of persons with ABI for one-year as well as the differences in proxy- and self-report versions of a QoL instrument. Method: The sample comprised 402 persons with ABI with ages ranging between 18 and 91 years, whom 36.20% had had the accident recently (i.e., three years or less). Patients, professionals and relatives responded at three evaluation points to the CAVIDACE scale, an ABI-specific QoL tool. Results: ANOVAs showed an improvement in QoL in the two follow-ups; the improvement was especially significant in the period between baseline and six months. The respondent factor did not interact with the evaluation time, but significant differences were found between respondents, with scores of patients higher than that for proxies. Finally, the QoL’s evolution interacts with the time elapsed since injury, showing significant improvements in the most recent group (i.e., three years or less). Conclusions: QoL must be considered from the earliest moments after ABI to obtain more significant improvements.     

Brief cognitive behavioral intervention for children and adolescents with persistent post-concussive symptoms: A pilot study

This study aims to evaluate the efficacy of a brief cognitive behavioral intervention program for children and adolescents experiencing persistent post-concussion symptoms. A total of 31 patients aged 10 to 18 years participated in the intervention. The median time since injury at treatment onset was 95 days though the range was large (23–720 days). Treatment was on average four sessions in duration. Sessions included concussion education, activity scheduling, sleep hygiene relaxation training, and cognitive restructuring. Outcomes were measured using symptom reports on the Sports Concussion Assessment Tool – Third Edition (SCAT-3) and parent-reported quality of life on the Pediatric Quality of Life Inventory (PedsQL). Mixed-effects models revealed that symptom reports did not decrease prior to the initiation of this treatment, though significant symptom improvement occurred following treatment. Quality of life scores significantly improved across domains, with the largest gains made in the emotional and school domains. Participant characteristics including age, sex, maternal education, and previous mental health problems were not found to be significantly related to treatment outcomes. Contrary to predictions, length of time since injury was not related to symptom changes. The primary limitation of this study is that it lacks randomization and an experimental control group. The results suggest that brief cognitive behavioral intervention may be a promising treatment for children and adolescents experiencing persistent post-concussive symptoms and warrants further investigation.     

Les préjudices professionnels des jeunes victimes de dommages corporels. La reconnaissance jurisprudentielle du préjudice professionnel des jeunes victimes. Partie 1

Compensation for professional damages in respect of young victims who remain disabled following an accident or assault remains problematic for personal injury compensation practitioners. However, such professional damages, recognized in principle by the Dintilhac group, were confirmed by the Court of Cassation in terms of full compensation for damages, both for loss of future earnings (PGPF), and professional incidence (IP). Though the burden of proof lies with the victim, experts have a major role to play in assessing these losses by setting out the foreseeable impact of the after-effects on the victim's professional activities, and on his or her professional potential before and after the injury, along with limitations in terms of the jobs the victim is subsequently able to do.